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Income Taxes - Deferred Tax Assets (Liabilities) (Details) - USD ($) | 12 Months Ended
--- | ---
Dec. 31, 2019 | Dec. 31, 2018
Deferred tax assets (liabilities) |  |
State taxes | $ 1,110,659 | $ 1,886,010
Stock options | 1,293,164 | 1,660,664
Accrued payroll and related cost | 277,682 | 238,633
Accrued hospital pool deficit | 188,075 | 168,413
Allowance for bad debts | 544,028 | 1,124,917
Investment in other entities | 2,977,431 | 884,922
Net operating loss carryforward | 13,849,685 | 6,414,256
Lease liability | 3,567,302 |
Property and equipment | (927,011) | (1,286,087)
Acquired intangible assets | (29,195,045) | (24,084,892)
Right-of-use assets | (3,544,315) |
Risk Pool Receivable | (1,623,049) | (2,434,573)
Other | 1,403,446 |
Other |  | (792,781)
Net deferred tax liabilities before valuation allowance | (10,077,948) | (16,220,518)
Valuation allowance | (8,191,500) | (3,395,417)
Net deferred tax liabilities | (18,269,448) | (19,615,935)
Deferred Tax Asset |  |
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward] |  |
Beginning balance | 3,395,417 | 3,224,517
Charged (credited) to tax expense | 1,085,842 | 170,900
Charged to goodwill | 3,710,241 | 0
Ending balance | $ 8,191,500 | $ 3,395,417

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